Provider Demographics
NPI:1710222419
Name:EAST VALLEY URGENT CARE,LLC
Entity type:Organization
Organization Name:EAST VALLEY URGENT CARE,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR EXECUTIVE VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRONBERG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:480-840-3075
Mailing Address - Street 1:855 E WARNER RD
Mailing Address - Street 2:STE F100
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-0997
Mailing Address - Country:US
Mailing Address - Phone:480-840-3075
Mailing Address - Fax:480-840-3025
Practice Address - Street 1:931 E ELLIOT RD
Practice Address - Street 2:SUITE 115
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1578
Practice Address - Country:US
Practice Address - Phone:480-840-3075
Practice Address - Fax:480-840-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care